Play Live Radio
Next Up:
0:00
0:00
Available On Air Stations

Midwives push for prenatal, postpartum care for incarcerated individuals

XT5F2196.JPG
Eze Amos
/
for VPM News
Heather Soper poses for a photo Wednesday, January 29, 2025, at The Village Prenatal Clinic in Waynesboro, Virginia. Soper, a Certified Nurse Midwife, also provides care to pregnant individuals incarcerated at the Middle River Regional Jail in Staunton.

State lawmakers would need to waive the Medicaid “inmate exclusion.”

Midwife Heather Soper believes pregnancy, birth and becoming a mother are transformational experiences. But when those life experiences happen while an individual is incarcerated, it adds a layer of complexity.

Soper donates her time to provide free prenatal care for women incarcerated at the Middle River Regional Jail in Staunton, VA through a partnership with the jail and Augusta Health.

She says while pregnant women who are being held long-term have coordinated prenatal care, those who are in and out of the jail are at particular risk. That’s when her services become critical.

“If she’s just in there for a short term thing, nobody’s looking to get her set up to see a provider,” Soper said.

Soper, who is also a Doctor of Nursing Practice, opened The Village Prenatal Clinic — a women’s health center which operates out of the Waynesboro Free Methodist Church — last September. She says she’s usually able to visit a pregnant inmate within 10 days of being contacted.

“I can’t think of a time that I’ve met with them where they didn’t break down in tears,” Soper said. “Just to let them talk about where they’re at in life.”

Soper’s clinic aims to provide free or low-cost care and support to women and girls who are navigating difficult financial and personal circumstances during their pregnancies. Part of the care Soper provides involves going into the jail in Augusta County, which she began doing last summer.

XT5F2150.JPG
Eze Amos
/
for VPM News
The Village Prenatal Clinic, located inside the Waynesboro Free Methodist Church, provides care to patients on Wednesdays.

“A lot of times they’re in and out of jail. They’ll be there for two to three weeks, and then they get out into the community and then a lot of times they’re back in again because they’re breaking their probation,” Soper said. “They don’t ever get prenatal care.”

The inmates she sees are at risk for preterm birth and low birth weight infants, which can happen when a pregnant person struggles with chronic stress or suffers from sexually transmitted infections.

“There was a girl that I was actually able to diagnose who had syphilis,” Soper said. “Because we knew that, she was able to get full treatment. The jail took her to the health department to get her antibiotics, and now her baby has a really great chance at a good outcome.”

If untreated, congenital syphilis — which has been on the rise in Virginia since 2013 — can cause miscarriage or premature birth, and babies born with the disease may have bone damage, anemia or nerve problems that could cause blindness.

Other common health issues associated with pregnancy — such as preeclampsia, hypertension and poor nutrition — have low-cost solutions, but can lead to costly health complications if left untreated. Soper says that’s why early detection and prevention are so important.

Despite the critical role she pays in care for imprisoned women, Soper does not get paid for her services at Middle River Jail. Currently, people who are incarcerated can’t enroll for insurance through Virginia’s Insurance Marketplace and do not qualify for Medicaid coverage.

There is a bipartisan effort at the General Assembly to address this lack of coverage during brief periods of incarceration for pregnant individuals. State Sen. Mamie Locke (D–Hampton) and Del. Carrie Coyner (R–Chesterfield) are sponsoring budget amendments requiring the state to allow a waiver of the “inmate exclusion” policy that would let incarcerated pregnant and postpartum individuals access 90 days of prenatal and postpartum care.

Last November, a Virginia Department of Criminal Justice Services working group recommended that the state consider allowing limited Medicaid coverage for pregnant individuals while serving time in jail.

In 2023, the Centers for Medicare & Medicaid Services began encouraging states to apply for waivers to help people getting out of incarceration — who often have complex or chronic conditions including mental health issues — more easily access health care. This guidance referenced the importance of family planning services for pregnant individuals who had been incarcerated.

Coyner said she’s focused on helping people who have been incarcerated successfully transition back into their communities.

“A big piece of that is ensuring that you are able to get reconnected as quickly as possible onto Medicaid if you qualify,” Coyner said. She hopes the Medicaid waiver can bridge the gap between services provided to people while they're incarcerated and the care that’s available to them once they’ve been released from jail.

“We know it is so critical for the health of the mom and the health of their infant that all of those various supports are in place,” Coyner said. “That’s really the intent, so that whether you’re incarcerated or immediately upon release, we’re ensuring that you have all the benefits of services that are needed for pre- and postnatal care.”

Coyner says the proposal “makes good financial sense,” because the waiver allows the state to be reimbursed for the cost of care through Medicaid. Victoria Richardson, an attorney at theVirginia Poverty Law Center, says that the prenatal and postpartum care will actually be cost saving.

“If this waiver could help keep a pregnant woman out of the emergency room, that's obviously cheaper than what Medicaid would have to pay otherwise,” she said.

XT5F1920.JPG
Eze Amos
/
for VPM News
The Village Prenatal Clinic, located inside the Waynesboro Free Methodist Church, is seen on Wednesday, January 29, 2025.

Former doula and Certified Professional Midwife Kathryn Haines, now the health equity manager at the Virginia Interfaith Center, has been advocating for the waiver. She estimates the change could help roughly 900 pregnant women currently incarcerated in the commonwealth, at a cost of about $2 million over two years.

“What it would do is provide continuity of care, especially with midwives, because of the ability to have longer visits and tackle some of the issues that this very vulnerable population might be facing.” Haines said. “It is also better financially, because when you’re a mom coming in and out of Medicaid, there’s an administrative cost.”

Haines said the average jail stay in Virginia is 90 days, and that the waiver’s timeframe would prevent a loss of coverage.

Soper and the group at Augusta Health Community Outreach have been able to identify and provide care for 15 pregnant women at the Middle River Regional Jail since 2023. In a Jan. 2 letter to state lawmakers, Soper explained the benefits of the care she’s provided “without any reimbursement for services” to pregnant inmates at the jail in Staunton.

“I encourage you to vote for Medicaid coverage so providers can be compensated for the care of this complex population and bring prenatal and postnatal care directly into the jails,” she wrote.

The legislature will consider the waiver as part of its budget amendment considerations on Sunday, Feb. 2.

Corrected: January 31, 2025 at 3:00 PM EST
Updated photo caption to reflect that Heather Soper is a Certified Nurse Midwife.
Adrienne is the video editor and health care reporter at VPM.